1/7. Multiple intestinal ulcerations and perforations secondary to methicillin-resistant staphylococcus aureus enteritis in infants.PURPOSE: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. methods: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. RESULTS: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of gram-positive cocci. (4) methicillin-resistant staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. CONCLUSIONS: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.- - - - - - - - - - ranking = 1keywords = enteritis (Clic here for more details about this article) |
2/7. aeromonas sobria infection with severe soft tissue damage and segmental necrotizing gastroenteritis in a patient with alcoholic liver cirrhosis.A 49-year-old man, who had a 3-year history of liver dysfunction but had not been treated, was admitted to the hospital with a sudden onset of fever and generalized muscle pain. He subsequently developed generalized purpura with scattered hemorrhagic bullae of the skin and massive bloody stools. aeromonas sobria was proven by culture of both blood and bullous fluid. In spite of the extensive treatment with antibiotics and other medications in the intensive care unit (ICU), the patient went into septic shock and died 2 days after admission. Pathological examination on autopsy revealed segmental necrotizing gastroenteritis with bacterial colonies and alcoholic liver cirrhosis, in addition to extensive severe soft tissue damage involving cellulitis and rhabdomyolysis and epidermolysis. Although the prognosis for vibrio vulnificus infection with severe soft tissue damage in patients with liver cirrhosis, malignancy, diabetes mellitus or other pre-existing diseases is poor, the unfavorable progression of aeromonas species, especially A. sobria infection is rare. This is thought to be the first report of an autopsied case.- - - - - - - - - - ranking = 1keywords = enteritis (Clic here for more details about this article) |
3/7. Enteritis necroticans (pigbel) in a diabetic child.BACKGROUND AND methods: Enteritis necroticans (pigbel), an often fatal illness characterized by hemorrhagic, inflammatory, or ischemic necrosis of the jejunum, occurs in developing countries but is rare in developed countries, where its occurrence is confined to adults with chronic illnesses. The causative organism of enteritis necroticans is clostridium perfringens type C, an anaerobic gram-positive bacillus. In December 1998, enteritis necroticans developed in a 12-year-old boy with poorly controlled diabetes mellitus after he consumed pig intestines (chitterlings). He presented with hematemesis, abdominal distention, and severe diabetic ketoacidosis with hypotension. At laparotomy, extensive jejunal necrosis required bowel resection, jejunostomy, and ileostomy. Samples were obtained for histopathological examination. Polymerase-chain-reaction (PCR) assay was performed on paraffin-embedded bowel tissue with primers specific for the cpa and cpb genes, which code for the alpha and beta toxins produced by C. perfringens. RESULTS: Histologic examination of resected bowel tissue showed extensive mucosal necrosis, the formation of pseudomembrane, pneumatosis, and areas of epithelial regeneration that alternated with necrotic segments--findings consistent with a diagnosis of enteritis necroticans. Gram's staining showed large gram-positive bacilli whose features were consistent with those of clostridium species. Through PCR amplification, we detected products of the cpa and cpb genes, which indicated the presence of C. perfringens type C. Assay of ileal tissue obtained during surgery to restore the continuity of the patient's bowel was negative for C. perfringens. CONCLUSIONS: The preparation or consumption of chitterlings by diabetic patients and other chronically ill persons can result in potentially life-threatening infectious complications.- - - - - - - - - - ranking = 0.6keywords = enteritis (Clic here for more details about this article) |
4/7. Ileoileal intussusception and ileal stricture associated with necrotizing enterocolitis in a premature infant: report of a case.A 630-g male infant developed presumed necrotizing enterocolitis (NEC) after fungal enteritis that resulted in subsequent fungal septicemia associated with pneumoperitoneum on the 9th day of life. Urgent percutaneous Penrose drainage was required. During the operation on the 14th day, an ileoileal intussusception and an ileal stricture were found with perforations on each oral side of the lesions. The distinction between NEC and intussusception in premature infants when they coexist can be difficult, as these conditions share common symptoms. The relation between ischemic injury and dysmotility of the intestine is also discussed. The similarity of intrauterine fetal distress and NEC in premature infants, as seen in the present case of the intussusception associated with focal NEC, suggests that mesenteric and enteric vascular ischemia could be one trigger of intussusception in neonates.- - - - - - - - - - ranking = 0.2keywords = enteritis (Clic here for more details about this article) |
5/7. Clostridial enteritis necroticans versus secondary clostridial infection superimposed upon ischemic bowel disease.Clostridial enteritis necroticans, or pig-bel, as seen in papua new guinea, is a necrotizing, segmental gangrene of the small intestine occurring in members of a malnourished population, who become ill after consuming large quantities of pork contaminated with Type C. clostridium perfringens. We report a case of possible Clostridial enteritis necroticans with concomitant ischemic intestinal disease secondary to superior mesenteric arterial thrombosis occurring in a 53-year-old woman with a long history of diabetes mellitus, hypertension, and peripheral vascular disease. The differential diagnosis and the pathogenesis of C. perfringens enteritis necroticans are discussed.- - - - - - - - - - ranking = 1.4keywords = enteritis (Clic here for more details about this article) |
6/7. Late graft loss after intestinal transplantation in an adult patient as a result of necrotizing enterocolitis.A 50-year-old recipient of an intestinal and coecal graft with sudden onset of abdominal distention and pain, lack of bowel movements, and vomiting after closure of the diagnostic ostomy 7 months after transplantation is reported. A plain abdominal radiograph revealed pneumatosis intestinalis. An angiography excluded obstruction of large vessels, however, with absent microcirculation of the intestine. Upper gastrointestinal endoscopy showed extensive ulcerative enteritis with several spontaneous perforations. The patient underwent exploration demonstrating a nonviable intestine. The entire necrotic intestine was removed. Vascular thrombosis was excluded. Clinical data, and macroscopic and histologic features of the intestinal graft were diagnostic for necrotizing enterocolitis (NEC). Though there has been evidence for the occurrence of NEC not only in premature infants but even in older infants, children and adolescents, the presented case is, to our knowledge, the first report of NEC as etiology of late graft loss after intestinal transplantation in an adult recipient.- - - - - - - - - - ranking = 0.2keywords = enteritis (Clic here for more details about this article) |
7/7. Necrotizing enterocolitis associated with clostridium perfringens type A in previously healthy north american adults.BACKGROUND: Necrotizing enteritis associated with clostridium perfringens type C ("pigbel") is a well-known syndrome in severely protein-deprived populations in the Pacific. It is exceedingly rare in the developed world. C perfringens type A is a common cause of acute gastroenteritis and, in a handful of infections, has been reported in association with a syndrome resembling necrotizing enteritis. STUDY DESIGN: This study includes a case series and literature review. charts and autopsy reports from four patients with adult necrotizing enterocolitis (ANEC) were reviewed. C perfringens isolates were subtyped by mouse bioassay and pulsed-field gel electrophoresis. Fixed tissue specimens were tested with an anticlostridial antibody using an immunohistochemical assay. RESULTS: Between 2000 and 2003, ANEC developed in four previously healthy men; three died. The small bowel was affected in three patients and the colon in two patients. Portal or mesenteric vein thrombosis occurred in three patients. C perfringens type A was isolated from three patients and immunohistochemical assay demonstrated clostridial antigens limited to affected areas of the intestine of all four. The nonculture positive patient had a strong epidemiologic link to one of the others, and a compatible clinical course. C perfringens of the same pulsed-field gel electrophoresis-defined molecular subtyped was isolated from stool samples of one patient, his wife, and food from a restaurant they patronized. CONCLUSIONS: ANEC associated with C perfringens type A infection occurred in four North American adults. culture for C perfringens type A should be performed in cases of ANEC. Alternative tests such as immunohistochemical assay were diagnostically useful. Additional research might uncover virulence factors, host factors, and the burden of disease in the population.- - - - - - - - - - ranking = 0.6keywords = enteritis (Clic here for more details about this article) |